Vancouver, British Columbia, Canada
April 12, 13, 14, 2013
Cascadia Seminar in Medical Anthropology
Medical anthropologists were invited to submit abstracts which were included in an extensive blind review by a committee of medical anthropologists on faculty at our various institutions, all of whom also plan to attend. The chosen abstracts promise to be ethnographically rich and intellectually exciting.
Epidemiological citizenship: The life history of a large-scale intervention in South India
This paper explores howt he Gates-funded HIV Initiative in India, known as Avahan, produces sociality – giving rise to what we conceptualize as a form of epidemiological citizenship. As groupings of highly diverse social actors participating in Avahan engage in the collective project of producing epidemiological evidence, new spaces of affinity, senses of obligation, demands for rights, patterns of reciprocity, and forms of antagonism and exclusion are produced. Drawing upon ethnographic research conducted between 2006-2012, we demonstrate how new kinds of societies emerge – as vast networks of community groups increasingly utilize epidemiological terms of reference (notions of space, time, pathogenesis, risk and security) to establish forms of social legitimacy, to claim a sense of belonging, and to foster accountability between members. We specifically illuminate how the social world of sex workers co-evolves with extensive surveillance procedures that are undergirded by contemporary philanthropic, managerial and entrepreneurial logics. While Avahan monitoring and evaluation specialists continually track and standardize the identities, behaviours and biologies of local populations through various mapping, typologization and random sampling procedures, which treat space and time as predictable variables, the participating sex workers simultaneously retranslate and reroute these standardizing processes into ‘‘the local’’ through the enactment of spatial management practices for health protection. These ‘‘sciences from below’’, to borrow Sandra Harding’s words, point to vital sites in the co-creation of scientific knowledge—where the quotidian practices and experiences of sex workers reassemble epidemiology, continually altering the very objects that surveillance experts are tracking. At a moment when Avahan’s innovations are being swiftly re-packaged and transported beyond India’s border, based on the assumption that the intervention’s ‘‘successes’’ can be understood solely through the definitive, linear and ultimate interpretations of epidemiologists, we insist that a fuller recognition of the co-production of epidemiological evidence as a continually moving process (that produces fragmented, multiple, hybrid and sometimes contradictory and ambiguous forms of epidemiological knowledge) opens up possibilities for more democratic engagement between scientists and sex workers, in ways that challenge the conventional boundaries of Epidemiological Authority in HIV prevention.
Intervals of Confidence: Uncertain Accounts of Hunger, Weight, and Global Health
For many in the highlands of Guatemala, where I conducted longterm ethnographic research on the emergence of the diagnosis of obesity, hunger was felt within the body as a sensation inextricably located in time and place. For epidemiologists working in the region, it was something quite different, determined through food frequency questionnaires and body mass indices. For global public health workers it was different still, operating as an indicator derived from agricultural and population statistics aiming to both represent and transcend geographic particularities. This paper draws these different versions of hunger together to explore the dilemmas confronted when studying an object that isn’t solid but – like the flesh and fat of bodies – is made and unmade variously. I use material from field working Guatemalan clinics and homes, and with FAO-funded scientists working to address global hunger, to examine the uncertainties that pervade global health analyses of hunger and the anthropological endeavor to make sense of them. Whereas international policy experts often organize hunger through scales of “the individual,” “the community,” and “the global,” I show how this mode of analysis does not simply report upon, but – much like the body weight scale – also produces and transforms the various bodies in question. I suggest that medical anthropology’s engagement with the unsettling ambiguities of “the everyday” offers an alternative method to scaling for shifting between localized, lived practices and numerical tabulations. The persistence of uncertainty may not, after all, be the liability it is often made out to be. More broadly, this examination of the partial connections between anthropology and global health suggests it is possible to care for those beyond ourselves, while staying within the realm of situated research and located politics.
Before and After the Return: Repatriating Indigenous DNA in a Genomic Age
Recent work in anthropology has pointed to increased sharing practices and collaboration as a way to develop more ethical approaches to the interpretation and ownership of biomedical genetic samples and data. In this paper, I explore the repatriation of 883 vials of blood and requisite documents from the University of Oxford back to the Nuu-Chah-Nulth First Nation in Canada twenty years after they were collected.
In 1983 one of the largest ever collections of blood from indigenous peoples in Canada for biomedical and genetics research was conducted in fourteen First Nations communities along the west coast of Vancouver Island. Those who gave blood signed a consent form provided by researchers agreeing to participate in a biomedical study on rheumatic disease. However, the samples were used in a range of secondary research exploring the ancestral and genetic origins of the Nuu-Chah-Nulth in the field of biological anthropology. Only after the death of the researcher who had originally collected the samples were the materials eventually returned to the west coast of Canada upon the request of the Nuu-Chah-Nulth Tribal Council.
By examining the travels and relations sustaining these materials, I offer an analysis of the cultural work that repatriable materials do before and after their return in the context of biomedicine. In extending an analysis of repatriation to recently collected DNA for biomedical research, my first aim is to attend to the transnational flows and stoppages that create the conditions for transatlantic journey and return. While the international circulation of biological samples and data from indigenous peoples in North America is not unusual, the return of it to the source community is. Moments of return reverberate beyond the case at hand and become enfolded and reactivated in current debates over ethics, identity and ownership in biomedicine. This case changed research ethics guidelines in Canada where indigenous DNA should be treated as ‘on loan’ to researchers. The second aim of the paper is to query this current thrust in contemporary biomedicine which seeks to bring biological materials under the domain of property in the name of ethics.
Anthropology and Insurance: Hidden Histories and Possible Futures
In her essay “Up the Anthropologist” (1969), Laura Nader used the example of a student’s ethnographic research on regulation of the insurance industry in the state of California to illustrate her vision of how anthropology might address the problems faced by citizens of contemporary democratic societies. Forty years later in Medical Anthropology Quarterly (2009), Society for Medical Anthropology President Carolyn Sargent recognized anthropology’s unique responsibility to contribute to public discourse and policy that would shape the resolution of the health insurance crisis in the United States (U.S.). Yet, in the decades separating the work of Nader and Sargent, medical anthropology developed neither a noteworthy body of knowledge about insurance nor a robust set of tools to address the epistemological and practical challenges posed by the study of insurance as a cultural phenomenon. Why is this so? How have medical anthropologists, in effect, become a people without insurance?
In the first part of this paper, I draw on Eric Wolf’s model of an anthropology that is sensitive to history, political economy, and ideology to explore a hidden history: why insurance has remained outside anthropology’s professional field of vision. I argue that just as insurance (as a tool that enables societies to deal with risk, uncertainty, and misfortune) shaped the development of the modern world, so, too, has it shaped the evolution of anthropology, from colonial and missionary ethnography to contemporary projects.
In the second part of this paper, in order to illustrate the challenges and the productive potential of medical anthropology research on insurance, I discuss 18 months of ethnographic research on the Defense Base Act, a U.S. federal workers’ compensation program for “military contractors,” the civilian employees of corporations that perform outsourced and privatized work in war zones and on military bases overseas. Through the exploration of variations in the post-war trajectories of a network of American truck drivers who were injured in a roadside ambush in Iraq in 2005, I outline pathways for future work on insurance - including its psychological, moral, political, economic, and social dimensions - in medical anthropology.
Attaching to Plastic – exploring the use of simulation based training in nursing education
In a historical perspective simulation in nursing education is nothing new. Making use of simulation has a long history in European and North American nursing programs, and the deployment of these methods in especially the 20th century is well-documented. But the development of sophisticated simulation technologies that permit learners to practice their skills without risking patient safety, is unique to this historical moment, and has positioned nursing education in the field of science and expertise in new ways.
In this paper I will explore what is often perceived to be at the center of nursing practice – namely care and, more specifically, the ability to make solid moral judgments in daily professional interactions between nurses and patients. The contemporary Norwegian philosopher-nurse Kari Martinsen work is prominent in Scandinavian nursing has been influential in shaping the present-day professional identity of nurses. Martinsen defines care as a trinity of relationality, practicality and morality (Martinsen 1991). Her compassionate notion of morality is one that expresses morality as an inner process and care as an always already openness and attachment towards the patient. As she argues, the human condition is one of social interdependence: “Care is to be concrete and present in a relationship by our senses and our bodies. It is always to be in a movement away from ourselves and towards the other” (Ibid.:11). But is this notion of care relevant when the interaction in question is one between plastic dummies and human students? And moreover, how do these interactions translate into the daily work of nurses in hospitals? My Main point in this paper is twofold. Firstly, I expand Martinsen’s notion of morality, by arguing that morality contains the ability to both attach and detach in relation to the patient. Secondly, although I saw examples of both attachment and detachment in both the skills lab and the hospital, these were different in character. By applying a post-phenomenological perspective I show how in the skills lab efforts were invested into ascending into attachments with plastic, while in the hospital efforts were invested into ascending into detachments with patients.
Discourse on the Fringe: Knowledge Production at the Borders of Medical Anthropology and Performance Studies (HIV/AIDS Theatre in South Africa)
Research on health communication and HIV policy making is a contentious issue in contemporary South Africa. HIV/AIDS has become one of the most publicized and politicized social issues in the post-apartheid era. Although government support for prevention, treatment, and care programs has recently increased, debates about how HIV/AIDS knowledge is conceptualized at local levels remain relevant amidst the country’s continuing health crisis. In response to historically narrow public health foci (based on rational choice or psychological theories of individual behavior change), applied theatre has emerged as a challenge to common health communication practices. This paper draws on 12 months of fieldwork with Johannesburg theatre participants, including in-depth interviews, participant-observation, and analysis of cultural products such as scripts and live HIV/AIDS theatre performances.
Utilizing ethnographic vignettes and theatre-maker discourse, this paper bridges the borders of the fields of medical anthropology and performance studies to provide an integrated perspective on contemporary applied theatre practices within South African health provision. It contributes to the integration of the fields by investigating theatre as a primary institution involved in HIV intervention practices. Using examples from fieldwork, this paper (1) analyzes live theatre interventions not only as a site of health information dissemination but as part of a social process involving critical reflection on the psychosocial, emotional, and structural factors associated with lived experience of HIV/AIDS and (2) discusses productive ways the disciplines of medical anthropology and performance studies may be integrated to contribute to interdisciplinary theory and practice related to health communication and knowledge production about HIV/AIDS.
Forgetting the House: Making and Unmaking Homes and Families
Aaron Seaman, University of Chicago
This paper is about the process of homes becoming strange and the ways that people are affected by, and attempt to deal with,such “estrangement.” Based on fieldwork conducted between 2008 and 2012 in the United States with people who have young-onset dementia and their families, I ask: What relationships emerge among family members, domestic space, and illness? How are they constituted? And how do they change across the course of an illness?I explore these questions through ethnographic evidence of how individuals with dementia and their caretakers remake the use of, and sentiments attached to, “the home.” In doing so, I offer a counterpoint to the long-held dichotomy of biomedical and domestic spaces and call into question the dominant narrative position of the clinic in medical anthropology and allied disciplines.
The moral stakes for families in the U.S. to provide care at home are staggering, with home generally imagined as a stabledomestic space of constancy, familiarity, and comfort. Given this, along with the relatively “low-tech” requirements of such care, people with young-onset dementia frequently spend several years of the illness at home, with their spouses often serving as the primary source of support. Yetas this paper illustrates through a focus on two spousal couples, not only do people’s relationships to the illness and each other change across time, but the meaning and import of “home” itself also fundamentally shift. For both families, spaces like closets and bathrooms, items like microwaves and shoes and family photos, and pathways between rooms all become increasingly strange for both the person with young-onset dementia and their spouse; by extension, people’s routines, schedules, and activities also change.Following these couples over time, however, this paper traces how people seek to re-constitute the domestic—a “place” of comfort, intimacy, and familial relations—not only within the home, but also, importantly, beyond its walls.
“Pensando Mucho” (“Thinking Too Much”): Uncertainty and Distress among Grandmothers in Nicaraguan Transnational Families
In this paper, I describe an embodied form of distress expressed by Nicaraguan grandmothers caring for children of migrant mothers, “pensando mucho” or “thinking too much”. Veena Das has argued that subjectivity is a contested field through which large-scale socio-political processes, changing family relations, and individual emotionality become “inescapably sutured together” (Das 1997). In this way, I argue that grandmothers’ subjective experiences of transnational migration reflect their complicated positionalities in global social processes of reproduction, as they respond to mother migration by upholding family life through their caregiving, and yet experience their roles as fragile and temporary given the prospects of children’s eventual reunification with mothers in destination countries. Medical anthropologists have illustrated how idioms of distress call attention not only to somatic and emotional pain, but also are employed by women as embodied resistance to social conditions of inequality (Nichter 1981; Low 1985; Finkler 1994). I extend these analyses into the contemporary context of Latin American transnational family life that structures grandmothers’ roles as what I call “mothers-in-the-meantime”. Tracing the political and economic transformations that push women to migrate and participate in what has been called the “global chain of reproductive labor” (Hochschild 2000), I situate Nicaraguan women’s subjective experiences of grandmothering within these global processes of stratified social reproduction. In particular, I show how grandmothering in transnational families is a deeply-ambivalent process, for women perceive their roles both as an opportunity to mother again for another generation of children, but also engage in caregiving against the uncertain prospect of children’s reunification with migrant mothers. In this way, I argue that “pensando mucho” is an embodied form of distress that registers grandmothers’ complaints about the threats to family unity and solidarity posed by transnational migration and also represents grandmothers’ assertion of the value of their caregiving labor in maintaining family wellbeing. Ultimately, this paper figures women of the “tercera edad” (grandmother generation) as central actors in transnational migration processes, and contributes to medical anthropological theorizing about the social and cultural contexts of women’s emotional and embodied distress.
Rachel Chapman (University of Washington)
Susan Erikson (Simon Fraser University)
Helen Chan (Simon Fraser University)